{include file="public/header"}
<div class="index_html huanzheliebiao add_new_patient flex_sign">
    {include file="public/nav"}
    <form action="" class="horizontal" method="post" role="form" >
<div class="list_box">
    <div class="title">
        <p>新建患者</p>
    </div>


    <div class="msg_box">
        <ul>
            <li>
                <div class="left">
                    <em>*</em>
                    <span>姓名：</span>
                </div>
                <div class="right">
                    <input type="text" name="name">
                </div>
            </li>
            <li>
                <div class="left">
                    <em>*</em>
                    <span>性别：</span>
                </div>
                <div class="right">
                    <select name="sex" id="sex">
                        <option value="1">男</option>
                        <option value="2">女</option>
                    </select>
                </div>
            </li>
            <li>
                <div class="left">
                    <em>*</em>
                    <span>证件类型：</span>
                </div>
                <div class="right" id="document_type">
                    <select name="document_type" >
                        <option value="1">身份证</option>
                        <option value="3">港澳通行证</option>
                        <option value="2">护照</option>
                    </select>
                </div>
            </li>
            <li>
                <div class="left">
                    <em>*</em>
                    <span>证件号：</span>
                </div>
                <div class="right">
                    <input type="text" name="document_num" id="idcard">
                </div>
            </li>
            <li>
                <div class="left">
                    <em>*</em>
                    <span>出生日期：</span>
                </div>
                <div class="right">
                    <script type="text/javascript">
                        $(function(){
                            $('.end_date_picker').date_input();
                        })
                    </script>
                    <div style="" class="input_box">
                        <input  style="" type="text" class="end_date_picker" value="" id="input1" name="birth">
                    </div>
                    <script>
                        $("#idcard").blur(function () {
                            //选择的身份证才进行验证
                            // alert($('#document_type option:selected').val());
                            if ($('#document_type option:selected').val() == '1') {
                                checkIdCard();
                            }

                        });
                    </script>
                </div>
            </li>
            <li>
                <div class="left">
                    <em>*</em>
                    <span>预留手机号：</span>
                </div>
                <div class="right">
                    <input type="text" name="phone">
                </div>
            </li>
        </ul>
        <div class="save_or_no">
            <a  class="cirtain">
                <input type="button" value="确定" class="ajax-post">
            </a>
            <!-- 如果 a 不需要 不起作用 把 a 里面的  href  属性去掉-->
            <a href="{:url('patient/index')}">
                取消
            </a>
        </div>
    </div>

</div>
    </form>
</div>
{include file="public/footer"}
